CTICasesDelayed Presentation of Myocardial Infarction with Left Ventricular Thrombus and Dressler's Syndrome
Imaging findings
There is low attenuation, angulated thrombus along the left ventricular apex. The left ventricular apical myocardium is not enhancing well, consistent with myocardial infarction. The coronary arteries show complete occlusion of the proximal LAD, with only a trickle of contrast likely from collaterals. There is also enhancement and stranding around the pericardium. An intra-aortic balloon pump is seen.
Key takeaways
This case demonstrates a dramatic subacute presentation of an ST-elevation myocardial infarction (STEMI) due to complete LAD occlusion. The patient, a runner, delayed presentation for five days, by which time revascularization was not deemed beneficial. The imaging findings are consistent with a delayed myocardial infarct, left ventricular thrombus formation, and post-MI pericarditis (Dressler's syndrome). A zero calcium score does not exclude an MI; non-calcified plaque rupture can lead to acute occlusion, especially in younger patients.
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